经皮克氏针内固定闭合复位治疗76例小儿肱骨髁上骨折

背景]分析小儿肱骨髁上骨折的复位、固定方法及手术时机与疗效的相关性.病例报告]选择1999年5月至2007年5月间以肱骨髁上骨折Gartland 2型以上接受手术治疗的76例患者为对象.骨折分类采用Gartland方法进行,2型者为44例,3型为32例.所有患者均行经皮克氏针内固定术闭合复位.治疗结果判定采用Flynn评价方法进行,术后未见发生骨不连及医源性尺神经麻痹的病例,发生肘内翻畸形者为4例,活动范围减小者为3例.骨折固定时使用克氏针数量、插入方向、受伤至手术时间差异与术后患者的功能恢复及肘内翻畸形等均无显著性相关.讨论]小儿肱骨髁上骨折手术治疗可行手法复位经皮外侧2枚克氏针平行固定,手术时机可根据具体情况进行判断.

Treatment for 76 cases of supracondylar humerus fractures by percutaneous close reduction internal fixation with Kirschner wire in children

BACKGROUND To analyze the dependability of the reduction,fixation methods,operation opportunity and curative effects of supracondylar humerus fractures in children.CASE REPORTS 76 cases of supracondylar humerus fractures were treated by operation from May 1999 to May 2007.The Gartland method was used to classify the fractures,including 44 cases of typeⅡand 32 cases of typeⅢ.All patients were treated by percutaneous close reduction internal fixation with Kirschner wire after manual reduction except one of radial nerve damage at the time of trauma.The Flynn method was used to compare the carrying angle and range of movement.There was no nonunion or iatrogenic ulnar nerve palsy after operation.4 cases of cubitus varus deformity and 3 cases of decrease in range of motion were observed as the complications.Functional results,cubitus varus deformity showed no statistical significance between each group which was divided according to the number of fixed pins used on the fracture,the direction of insertion,and the length of time between trauma and the time of operation.DISCUSSION The supracondylar humerus fractures in children could be performed by using manual reduction and 2 parallel fixation with Kirschner wire laterally,and the operation opportunity may be decided according to the status.